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					                                                                               Rachel Joy Tancioco
                                                                                           Batch 8
                                                                                     June 15, 2009

                             Questions Assignment with Rationale
                     for Trigeminal Neuralgia, Guillaine-Barre Syndrome,
                                 Bell's Palsy and Meningitis

1. Trigeminal Neuralgia is caused by degeneration of or pressure on what cranial nerve?
   a. Cranial Nerve III
   b. Cranial Nerve IV
   c. Cranial Nerve V
   d. Cranial Nerve VI

   Answer: C
   Rationale: Trigeminal Neuralgia is caused by degeneration of or pressure on cranial nerve V.
   from which the word of cranial nerve V as Trigeminal nerve. Strategy for this kind of question
   is that examinee should know the mnemonics for the cranial nerves.
   Source: Foundations and Adult Health Nursing 5th edition by Christensen and Kockrow on
   page 1976


2. A nurse has given suggestions to the client with trigeminal neuralgia about strategies to
   minimize episodes of pain. The nurse determines that the client needs additional information if
   the client made which of the following statements?
   a. “I will wash my face with cotton pad.”
   b. “I'll have to start chewing on the unaffected side.”
   c. “I should rinse my mouth if toothbrushing is painful.”
   d. “I will try to eat my food either very warm or very cold.”

   Answer: D
   Rationale: Facial pain can be minimized by using cotton pads to wash the face, using room
   temperature water. The client should chew on the unaffected side of the mouth, eat a soft diet,
   and take in foods and beverages at room temperature. If toothbrushing triggers pain, sometimes
   an oral rinse after meals is helpful instead. Strategy: Recalling that the pain of trigeminal
   neuralgia is triggered by mechanical or thermal stimuli will direct you to the correct option.
   Remember, very hot or cold foods are likely to trigger the pain, not relieve it.
   Sources: Comprehensive Review for the NCLEX-PN Examination 4th edition by Silvestri on
   page 836 # 765

3. What are the primary branches of trigeminal nerve affected by Trigeminal Neuralgia?
   a. Maxillary branches
   b. Opthalmic branches
   c. Mandibular branches
   d. A and C are correct

   Answer: D
   Rationale: In trigeminal neuralgia the sensory or afferent branches, primarily the maxillary and
   mandibular branches, are involved. Strategy: Examinee should know the affected part of the
   face that the client mostly experiences the pain particularly in the lips, upper or lower gums,
   cheek, forehead, or side of the nose. In these disorder it does not include the opthalmic part of
   the face.
   Source: Foundations and Adult Health Nursing 5th edition by Christensen and Kockrow on
   page 1976

4. A nurse is preparing for the admission of a client with a suspected diagnosis of Guillaine- Barre
   Syndrome. The client arrives to the nursing unit and the nurse is reviewing the physician's
   documentation the nurse expects to note documentation of which hallmark clinical
   manifestation of this syndrome?
   a. Altered LOC
   b. Multifocal seizures
   c. Abrupt onset of fever and headache
           d. Development of Muscle weakness

   Answer: D
   Rationale: A hallmark clinical manifestation of Guillaine – Barre syndrome is muscle weakness
   that develops rapidly. The client does have symptoms such as fever or headache. Cerebral
   function, LOC and pupillary responses are normal seizures sypmptons and are not normally
   associated with this disorder.
   Source: Introduction to Medical-Surgical Nursing 4th edition on page 444

5. A nursing student is collecting data on a client recently diagnose with meningitis. The student
   expects to note which of the following signs and symptoms? Select all that apply.
   a. Diarrhea
           b. Tachycardia
   c. Tinnitus
   d. Photophobia
   e. Red, Macular Rash
   f. Positive Kernig's sign

   Answers: B, D, E, and F
   Rationale: Meningitis is an infection or inflammation of the meninges covering the brain and
   spinal cord. Signs and symptoms can include a positive Kernig's sign, tachycardia, a red,
   macular rash, and photophobia. Other manifestations include severe headache, stiffness of the
   neck, irritability, malaise and restlessness. Diarrhea and tinnitus are not usually associated with
   meningitis.
   Source: Foundations and Adult Health Nursing 5th edition by Christensen and Kockrow on
           page 1979

6. A nurse is admitting a client with Guillaine-Barre syndrome to the nursing unit. The client has
   an ascending paralysis to the level of the waist. Knowing the complications of the disorder, the
   nurse brings which of the following items into the client's room?
   a. Nebulizer and pulse oximeter
   b. Blood Pressure Cuff and flashlight
   c. Flashlight and incentive spirometer
   d. ECG monitoring electodes and intubation tray

   Answer: D
   Rationale: The client with Guillaine-Barre syndrome is at risk for respiratory failure because of
   ascending paralysis. An intubation tray should be available for use. Another complication of
   this syndrome is cardiac dysrhythmia, which necessitates the use of ECG monitoring. Because
   the client is immobilized the nurse should routinely assess for the deep vein thrombosis and
   pulmonary embolism.
   Source: Medical-Surgical Nursing: Critical Thinking for Collaborative Care by D. Ignatavicius
   5th edition on page 1009 -1010.

7. A client is seen by the physician and Bell's Palsy is suspected. Which of the following signs
   and symptoms would the nurse expect to note in the client if this disorder is present?
   a. Tingling sensations of the eyelid
   b. Burning pain in the nose with intermittent facial paralysis
   c. Speech or chewing difficulties accompanied by facial drop
   d. stabbing facial pain with intermittent tingling sensations in the eyes

   Answer: C
   Rationale: Bell's Palsy is a one-sided facial paralysis from compression of the facial nerve, CN
   VII. There is facial droop from paralysis of the facial muscles, increased lacrimation, speech or
   chewing difficulties, and painful sensations in the eyes, in the face, or behind the ear. Options
   A, B, and D are not characteristics of Bell's Palsy
   Source: Medical-Surgical Nursing: Concepts and Practice by S. deWit on page 589 year 2009

8. A client experiences an episode of Bell's Palsy and complains about increasing clumsiness. The
   nurse should prepare the client for which diagnostic study(ies) to determine the cause of the
   complaints? Select all that apply.
   a. Serum Sodium level
   b. Cerebral Angiography
   c. Lumbar Puncture (LP)
   d. Oculovestibular Reflex
   e. Electroencephalogram
   f. Computed Tomography

   Answer: B, C and F
   Rationale: Bell's Palsy can be caused by inflammation or a lesion of the facial nerve and when
   the client presents with both BP and increasing clumsiness, the health care team suspects more
   diffuse CNS lessions. The most sensitive and specific tests that provide relevant diagnostic
   information for these types of pathology are cerebral angiography, lumbar puncture and
   computed tomography. The imaging studies illustrate CNS lesions, and the lumbar puncture
   enables the care provider to analyze CSF for immunoglobulins (antibodies) and other
   components. Because the clients neurological problem is unlikely to be metabolic , the sodium
   level is unlikely to be helpful. Usually EEG and oculovestibular reflex are tests reserved to
   evaluate electrical activity of the brain in seizure disorders and to determine brain death. In
   addition, the oculovestibular reflex is not performed on a client who is conscious.
   Source: Medical-Surgical Nursing: Health and Illness perspectives by F. Monahan, J. Sands, J.
   Marek and M. Neighbor 7th edition on pages 1414-1415

9. A nurse is caring for a client diagnosed with Bell's Palsy 1 week ago. Which of the following
   data would indicate a potential complication associated with Bell's Palsy?
   a. partial facial paralysis
   b. excessive tearing
   c. negative outcomes on the electromyogram
   d. the ability to taste the food

   Answer: B
   Rationale: Complications of Bell's Palsy include abnormal regeneration of the nerve “crocodile
   tears (autonomic fibers reconnect to the lacrimal duct instead of the salivary glands, so the
   client develops excessive tearing while eating.); abnormal facial movements due to
   reinnervation of inappropriate muscle; and spasms, atrophy and contractures due to incomplete
   motor fiber innervation. Partial facial paralysis is a factor indicating recovery. Negative
   outcomes on the electromyography performed 1 week after symptoms onset indicate that nerve
   regeneration is present (negative test indicates a positive prognostic outcome). Tasting food 1
   week after the symptom onset indicates a good prognosis for recovery.
   Source: Introduction to Medical-Surgical Nursing 4th edition by A. Linton on page 457

10. A client complains of pain in the lower back and pain and spasms in the hamstring when the
    nurse attempt to extend the client's leg. How should the nurse record this finding on the client's
    medical record?
    a. Positive Kernig's sign
    b. Positive Babinski's sign
    c. Positive Trousseau's sign
    d. Positive Brudzinski's sign

   Answer: A
   Rationale: Both Kernig's and Brudzinski's signs are suggestive of meningeal irritation, which
   occurs in meningitis. A positive Kernig's sign is the inability to extend the leg from a 90 degree
   flexion at the hip. Attempts to extend the leg cause pain and spasms in the hamstring muscles.
   With positive Brudzinki's sign, passive flexion of the head and neck causes flexion of the thighs
   and legs. Positive Trousseau's sign is carpopedal spasm observed in the hypocalcemic client
   when a BP cuff is inflated on the arm above the systolic pressure. A Babinski's reflex is elicited
   when the nurse strokes along the sole of the foot.
   Source: Physical Examination and Health Assessment 5h edition by C. Jarvis on page 710

				
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